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Tan AYS, Tan MS, Wu A, Seah AC, Chong C, Koh E, Tan NC. Self-administered oral glucose tolerance test with capillary glucose measurements for the screening of diabetes mellitus in high-risk adults: a feasibility study. BMJ Open Diabetes Res Care 2021; 9:9/2/e002556. [PMID: 34952842 PMCID: PMC8710854 DOI: 10.1136/bmjdrc-2021-002556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/23/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early diagnosis of prediabetes based on blood sampling for the oral glucose tolerance test (OGTT) is crucial for intervention but multiple barriers hinder its uptake. This study aimed to assess the feasibility and precision of a self-administered capillary OGTT for type-2 diabetes mellitus (T2DM) in high-risk individuals. RESEARCH DESIGN AND METHODS Participants with history of gestational diabetes or prediabetes were recruited in primary care. Due to their prediabetic status and previous diagnosis of gestational diabetes mellitus, a proportion of participants had previous experience doing OGTT. They self-administered the capillary OGTT and concurrently their venous glucose samples were obtained. They filled a questionnaire to collect their demographic information, views of their capillary OGTT, and their preferred site of the test. RESULTS Among 30 participants enrolled in this feasibility study, 93.3% of them felt confident of performing the capillary OGTT themselves, and 70.0% preferred the test at home. Older, less educated participants found it less acceptable. Mean capillary glucose values were significantly higher than venous glucose values, with mean difference at 0.31 mmol/L (95% CI 0.13 to 0.49) at fasting, and 0.47 mmol/L (95% CI 0.12 to 0.92) 2 hours post-OGTT. Capillary and venous glucose measurements were correlated for fasting (r=0.95; p<0.001) and 2-hour-post-OGTT (r=0.95;p<0.001). The Fleiss-Kappa Score (0.79, p<0.0001) indicated fair agreement between the two methods. The capillary OGTT had excellent sensitivity (94.1%) and negative predictive value (NPV=91.7%) in identifying prediabetes or T2DM status, vis-a-vis to venous glucose samples. CONCLUSION Self-administered capillary OGTT is feasible and acceptable, especially among younger adults, with excellent sensitivity and NPV compared with plasma-based OGTT.
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Affiliation(s)
| | - Mui Suan Tan
- SingHealth Polyclinics, Singapore
- Family Medicine Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | | | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- Family Medicine Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore
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Al-Rifai RH, Abdo NM, Paulo MS, Saha S, Ahmed LA. Prevalence of Gestational Diabetes Mellitus in the Middle East and North Africa, 2000-2019: A Systematic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2021; 12:668447. [PMID: 34512543 PMCID: PMC8427302 DOI: 10.3389/fendo.2021.668447] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Women in the Middle East and North Africa (MENA) region are burdened with several risk factors related to gestational diabetes mellitus (GDM) including overweight and high parity. We systematically reviewed the literature and quantified the weighted prevalence of GDM in MENA at the regional, subregional, and national levels. Studies published from 2000 to 2019 reporting the prevalence of GDM in the MENA region were retrieved and were assessed for their eligibility. Overall and subgroup pooled prevalence of GDM was quantified by random-effects meta-analysis. Sources of heterogeneity were investigated by meta-regression. The risk of bias (RoB) was assessed by the National Heart, Lung, and Blood Institute's tool. One hundred and two research articles with 279,202 tested pregnant women for GDM from 16 MENA countries were included. Most of the research reports sourced from Iran (36.3%) and Saudi Arabia (21.6%), with an overall low RoB. In the 16 countries, the pooled prevalence of GDM was 13.0% (95% confidence interval [CI], 11.5-14.6%, I2 , 99.3%). Nationally, GDM was highest in Qatar (20.7%, 95% CI, 15.2-26.7% I2 , 99.0%), whereas subregionally, GDM was highest in Gulf Cooperation Council (GCC) countries (14.7%, 95% CI, 13.0-16.5%, I2 , 99.0%). The prevalence of GDM was high in pregnant women aged ≥30 years (21.9%, 95% CI, 18.5-25.5%, I2 , 97.1%), in their third trimester (20.0%, 95% CI, 13.1-27.9%, I2 , 98.8%), and who were obese (17.2%, 95% CI, 12.8-22.0%, I2 , 93.8%). The prevalence of GDM was 10.6% (95% CI, 8.1-13.4%, I2 , 98.9%) in studies conducted before 2009, whereas it was 14.0% (95% CI, 12.1-16.0%, I2 , 99.3%) in studies conducted in or after 2010. Pregnant women in the MENA region are burdened with a substantial prevalence of GDM, particularly in GCC and North African countries. Findings have implications for maternal health in the MENA region and call for advocacy to unify GDM diagnostic criteria. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018100629.
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Affiliation(s)
- Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- *Correspondence: Rami H. Al-Rifai,
| | - Noor Motea Abdo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marília Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sumanta Saha
- Department of Community Medicine, R. G. Kar Medical College, Kolkata, India
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Sánchez-García A, Rodríguez-Gutiérrez R, Saldívar-Rodríguez D, Guzmán-López A, Castillo-Castro C, Mancillas-Adame L, Santos-Santillana K, González-Nava V, González-González JG. Diagnostic accuracy of the triglyceride-glucose index for gestational diabetes screening: a practical approach. Gynecol Endocrinol 2020; 36:1112-1115. [PMID: 32233827 DOI: 10.1080/09513590.2020.1742687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The oral glucose tolerance test (OGTT) remains as the gold standard to diagnose gestational diabetes mellitus (GDM); however, this test may be inconvenient and costly. Hence, other easy to perform and accurate diagnostic alternatives would be valuable for maternal care. The objective of the study was to assess the diagnostic performance of the TyG index to screen for GDM at 24-28 of pregnancy. A total of 140 pregnant women who received the one-step 2 h 75 g OGTT were included. Overall GDM prevalence was 27.1% according to IADSPG criteria. The mean TyG index value in the GDM group was significantly higher than the TyG index for the no GDM group (4.88 ± 0.70 versus 4.68 ± 0.19, p<.001). A sensitivity of 89% [95% CI 0.75-0.97] and a specificity of 50% [95% CI 0.39-0.60)], accompanied by a high negative predictive value of 93% was observed. No differences were found in maternal and neonatal outcomes irrespective of the TyG cutoff value for GDM. According to our results, the TyG index may be a highly sensitive and easy to perform screening test for GDM.
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Affiliation(s)
- Adriana Sánchez-García
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Monterrey, Nuevo León, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Research Unit, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - Donato Saldívar-Rodríguez
- Obstetrics and Gynecology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - Abel Guzmán-López
- Obstetrics and Gynecology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - Carolina Castillo-Castro
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - Leonardo Mancillas-Adame
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Monterrey, Nuevo León, Mexico
| | - Karla Santos-Santillana
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - Victoria González-Nava
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Monterrey, Nuevo León, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Monterrey, Nuevo León, Mexico
- Facultad de Medicina y Hospital Universitario "Dr Jose Eleuterio Gonzalez", Research Unit, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
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Liu Y, Guo H, Wang Q, Lian D, Yang M, Huang K, Chen J, Xuan Y, Zhang J, Wei Q, Fang S, Xu J, Liu Y, Sun K, Sun Z, Wang B. Use of capillary glucose combined with other non-laboratory examinations to screen for diabetes and prediabetes. Diabet Med 2019; 36:1671-1678. [PMID: 31392737 DOI: 10.1111/dme.14101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the value and feasibility of capillary glucose assessment, combined with other non-laboratory measures, in screening for diabetes and prediabetes in the community. METHODS In this cross-sectional study, we assessed fasting capillary glucose, fasting plasma glucose, and both capillary glucose and plasma glucose values after 2-h oral glucose tolerance tests in a total of 3736 samples. We determined the optimal threshold of capillary glucose using receiver-operating characteristic curve analysis. The effect of screening methods using capillary glucose combined with other variables, such as age, BMI and waist circumference, was assessed according to area under the receiver-operating characteristic curve. RESULTS There was a strong positive correlation between capillary glucose and venous plasma glucose. The area under the curve for the model using fasting capillary glucose to screen for impaired fasting glucose was 0.722, while that for the model using capillary glucose after a 2-h oral glucose tolerance test to screen for impaired glucose tolerance was 0.916. The area under the curve for the model using fasting capillary glucose to screen for diabetes was 0.835, while that for the model using 2-h oral glucose tolerance test capillary glucose was 0.912. The area under the curve for the model using fasting capillary glucose + 2-h oral glucose tolerance test capillary glucose to screen for diabetes was 0.945. The discriminatory capability of models using capillary glucose was somewhat improved by adding non-laboratory variables. CONCLUSIONS Capillary glucose could be an alternative for screening for diabetes and prediabetes, especially in low-resource areas.
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Affiliation(s)
- Yuxiang Liu
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Haijian Guo
- Integrated Business Management Office, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Qing Wang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Dashuai Lian
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Man Yang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Kaiping Huang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Jianshuang Chen
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Yan Xuan
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Jiarong Zhang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Qiankun Wei
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | | | - Jinshui Xu
- Integrated Business Management Office, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yu Liu
- Centre for Disease Control and Prevention, Jurong, Jiangsu, China
| | - Kaicheng Sun
- Centre for Disease Control and Prevention, Yandu, Jiangsu, China
| | - Zilin Sun
- Department of Endocrinology, Institute of Diabetes, Medical School, Southeast University, Nanjing, Jiangsu, China
| | - Bei Wang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pastakia SD, Njuguna B, Onyango BA, Washington S, Christoffersen-Deb A, Kosgei WK, Saravanan P. Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods. BMC Pregnancy Childbirth 2017; 17:226. [PMID: 28705184 PMCID: PMC5513206 DOI: 10.1186/s12884-017-1415-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 07/05/2017] [Indexed: 01/11/2023] Open
Abstract
Background Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Methods Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Results Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. Conclusions POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required. Trials registration Clinical trials.gov: NCT02978807, Registered 29 November 2016.
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Affiliation(s)
- Sonak D Pastakia
- Department of Pharmacy Practice, Purdue Kenya Partnership, PO Box 5760, Eldoret, 30100, Kenya.
| | - Benson Njuguna
- Department of Pharmacy, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya
| | - Beryl Ajwang' Onyango
- Department of Pharmacy, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya
| | - Sierra Washington
- Department of Reproductive Medicine, University of California, San Diego, CA, 92103, USA
| | | | - Wycliffe K Kosgei
- Division of Reproductive Health, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya
| | - Ponnusamy Saravanan
- Department of Diabetes, Endocrinology & Metabolism, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Diabetes and Endocrine Centre, George Eliot Hospital, Nuneaton, CV107DJ, UK
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Yan Y, Liu Z, Liu D. Heterogeneity of glycometabolism in patients with gestational diabetes mellitus: Retrospective study of 1,683 pregnant women. J Diabetes Investig 2017; 8:554-559. [PMID: 27863107 PMCID: PMC5497052 DOI: 10.1111/jdi.12595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/05/2016] [Accepted: 11/06/2016] [Indexed: 01/14/2023] Open
Abstract
AIMS/INTRODUCTION To evaluate the glycometabolism and outcomes of gestational diabetes mellitus (GDM) patients according to the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria in China. MATERIALS AND METHODS According to the results of a 75-g oral glucose tolerance test, 1,683 pregnant women were divided into three groups: (i) an increment GDM group (patients meet the IADPSG criteria, but not the previous Chinese criteria); (ii) a stock GDM group (patients meet both criteria); and (iii) a normal glucose tolerance group. Their glycometabolism outcomes, prepregnancy and postpartum body mass index were compared, as were maternal-fetal outcomes. RESULTS The IADPSG and previous Chinese criteria diagnosed 12.4% and 5.5% of women with GDM. Pairwise comparison showed significant differences in 1-h plasma glucose, 2-h plasma glucose, HbA1c values and area under curve of glucose among all groups (P < 0.01). The fasting plasma glucose and postpartum body mass index of the stock group were significantly higher than those of the other two groups (P < 0.01). The incidences of hypertensive disorder complicating pregnancy and cesarean section of the normal glucose tolerance group were significantly lower than those of the other two groups (P < 0.001). No significant differences in patient age, prepregnancy body mass index, duration of pregnancy, prevalence of premature labor, premature rupture of membranes, neonatal jaundice, neonatal asphyxia or Ponderal Index were observed, but significant differences in macrosomia and neonatal hypoglycemia were observed (P < 0.05). CONCLUSIONS The IADPSG criteria doubled the number of GDM patients. The cases of the increment patients were mild. The IADPSG criteria should be discussed fully before implementation in China.
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Affiliation(s)
- Yan Yan
- Department of ObstetricsShanghai First Maternity and Infant HospitalTongji UniversityShanghaiChina
| | - Zhou Liu
- Department of Obstetrics and GynecologyShanghai Zhoupu HospitalShanghaiChina
| | - Daqing Liu
- Department of Obstetrics and GynecologyShanghai Seventh People's HospitalShanghaiChina
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Petrović O, Belci D. A critical appraisal and potentially new conceptual approach to screening and diagnosis of gestational diabetes. J OBSTET GYNAECOL 2017; 37:691-699. [PMID: 28467229 DOI: 10.1080/01443615.2017.1306692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this article was a critical appraisal of current GDM screening and diagnosis status as well as a presentation of a potentially new approach to this perinatologic and public health problem of increasing clinical significance. Medline, EMBASE and Cochrane databases were searched. Most professional organisations recommend universal screening at 24-28 weeks of gestation, while some of them state that selective screening could also be recommended. Expert opinions regarding GDM diagnosis significantly differ throughout the world. Authors call for an open and broad professional and scientific discussion and suggest a combination of screening and diagnosis procedures in a form of one-step 1-h screening method, creation of regional GDM diagnostic criteria and standardisation of outcome-based randomised control trials. They also advise introduction of a conceptually new approach, where the risk of hyperglycaemia rather than insisting on GDM diagnosis itself should be detected.
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Affiliation(s)
- Oleg Petrović
- a Department of Gynaecology and Obstetrics, Perinatal Unit , University Hospital Centre Rijeka , Rijeka , Croatia
| | - Dragan Belci
- b Department of Gynaecology , General Hospital Pula , Pula , Croatia
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Agarwal MM. Gestational diabetes mellitus: Screening with fasting plasma glucose. World J Diabetes 2016; 7:279-89. [PMID: 27525055 PMCID: PMC4958688 DOI: 10.4239/wjd.v7.i14.279] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/30/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
Fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) has had a checkered history. During the last three decades, a few initial anecdotal reports have given way to the recent well-conducted studies. This review: (1) traces the history; (2) weighs the advantages and disadvantages; (3) addresses the significance in early pregnancy; (4) underscores the benefits after delivery; and (5) emphasizes the cost savings of using the FPG in the screening of GDM. It also highlights the utility of fasting capillary glucose and stresses the value of the FPG in circumventing the cumbersome oral glucose tolerance test. An understanding of all the caveats is crucial to be able to use the FPG for investigating glucose intolerance in pregnancy. Thus, all health professionals can use the patient-friendly FPG to simplify the onerous algorithms available for the screening and diagnosis of GDM - thereby helping each and every pregnant woman.
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Agarwal MM, Shah SM, Al Kaabi J, Saquib S, Othman Y. Gestational diabetes mellitus: Confusion among medical doctors caused by multiple international criteria. J Obstet Gynaecol Res 2014; 41:861-9. [DOI: 10.1111/jog.12661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/05/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Mukesh M. Agarwal
- Department of Pathology; UAE University; Al Ain United Arab Emirates
| | - Syed M. Shah
- Department of Public Health; UAE University; Al Ain United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine; College of Medicine; UAE University; Al Ain United Arab Emirates
| | - Shabnam Saquib
- Department of Obstetrics and Gynecology; Dubai Hospital; Dubai United Arab Emirates
| | - Yusra Othman
- Department of Pathology; Tawam Hospital; Al Ain United Arab Emirates
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11
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McIntyre HD, Colagiuri S, Roglic G, Hod M. Diagnosis of GDM: a suggested consensus. Best Pract Res Clin Obstet Gynaecol 2014; 29:194-205. [PMID: 25242583 DOI: 10.1016/j.bpobgyn.2014.04.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/13/2014] [Indexed: 01/27/2023]
Abstract
Despite recent attempts at building consensus, an internationally consistent definition of gestational diabetes mellitus (GDM) remains elusive. Within and between countries, there is disagreement between obstetric, medical, and endocrine groups as to the diagnosis and management of GDM. The current article aims to discuss the background to the controversy of GDM diagnosis and to address issues related to the detection and treatment of GDM in low-, middle-, and high-resource settings. The criteria recommended by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the American Diabetes Association (ADA), and the World Health Organization (WHO) are endorsed. We also wish to put into perspective the importance of GDM, both during and after pregnancy, in terms of its relationship to overall women's health.
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Affiliation(s)
- Harold David McIntyre
- University of Queensland and Mater Health Services, South Brisbane, QLD 4101, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition & Exercise, G89 Medical Foundation Building K25, Sydney Medical School, The University of Sydney, NSW 2000, Australia.
| | - Gojka Roglic
- Department of Management of Noncommunicable Chronic Diseases, World Health Organization, Geneva, Switzerland.
| | - Moshe Hod
- Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tiqva 49100, Israel.
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12
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Colagiuri S, Falavigna M, Agarwal MM, Boulvain M, Coetzee E, Hod M, Meltzer SJ, Metzger B, Omori Y, Rasa I, Schmidt MI, Seshiah V, Simmons D, Sobngwi E, Torloni MR, Yang HX. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract 2014; 103:364-72. [PMID: 24731475 DOI: 10.1016/j.diabres.2014.02.012] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 02/07/2023]
Abstract
The World Health Organization (WHO) has recently released updated recommendations on Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy which are likely to increase the prevalence of gestational diabetes mellitus (GDM). Any increase in the number of women with GDM has implications for health services since these women will require treatment and regular surveillance during the pregnancy. Some health services throughout the world may have difficulty meeting these demands since country resources for addressing the diabetes burden are finite and resource allocation must be prioritised by balancing the need to improve care of people with diabetes and finding those with undiagnosed diabetes, including GDM. Consequently each health service will need to assess their burden of hyperglycaemia in pregnancy and decide if and how it will implement programmes to test for and treat such women. This paper discusses some considerations and options to assist countries, health services and health professionals in these deliberations.
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Affiliation(s)
- Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, The University of Sydney, Sydney, Australia.
| | - Maicon Falavigna
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mukesh M Agarwal
- Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Michel Boulvain
- Service d'Obstétrique Maternité HUG, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Edward Coetzee
- Department Obstetrics & Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Tel-Aviv, Israel
| | - Sara J Meltzer
- Department of Medicine, McGill University, Montreal, Canada; Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada
| | - Boyd Metzger
- Northwestern University, Feinberg School of Medicine, Chicago, United States
| | - Yasue Omori
- Tokyo Women's Medical University, Diabetes Center, Ebina General Hospital, Tokyo, Japan
| | - Ingvars Rasa
- Rīga East Clinical University Hospital, Rīga Stradiņš University, Rīga, Latvia
| | - Maria Inês Schmidt
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Veerasamy Seshiah
- Diabetes Research Institute, Dr Balaji Diabetes Care Centre, Chennai, India
| | - David Simmons
- Institute of Metabolic Science, Cambridge University Hospitals, National Health Services Foundation Trust, Cambridge, United Kingdom
| | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon; Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | | | - Hui-xia Yang
- Peking University First Hospital, Beijing, China
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Agarwal MM, Dhatt GS. Comment on zhu et Al. Fasting plasma glucose at 24-28 weeks to screen for gestational diabetes mellitus: new evidence from china. Diabetes care 2013;36:2038-2040. Diabetes Care 2014; 37:e33. [PMID: 24459162 DOI: 10.2337/dc13-2035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Anderson V, Ye C, Sermer M, Connelly PW, Hanley AJG, Zinman B, Retnakaran R. Fasting capillary glucose as a screening test for ruling out gestational diabetes mellitus. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:515-522. [PMID: 23870775 DOI: 10.1016/s1701-2163(15)30909-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A common approach to screening for gestational diabetes mellitus (GDM) is the testing of all pregnant women with a one-hour, 50 g glucose challenge test (GCT), followed by a diagnostic oral glucose tolerance test (OGTT) when the GCT is positive (≥ 7.8 mmol/L). As only a small subset of those with a positive GCT will have GDM, many more women undergo the OGTT than may be necessary. In this context, we hypothesized that measurement of fasting capillary glucose (FCG) could provide a strategy for reducing the number of unnecessary OGTTs. Thus, we sought to identify a threshold level of FCG below which GDM could be ruled out following a positive GCT, without need for the OGTT. METHODS Following a positive GCT, 888 women underwent measurement of FCG prior to their OGTT. We evaluated the test characteristics of FCG for identifying the 209 women diagnosed with GDM on the OGTT. RESULTS Fasting capillary glucose was positively associated with each glucose measurement on the OGTT (all P < 0.001) and inversely related to insulin sensitivity and pancreatic beta-cell function (both P < 0.001). As FCG increased, the prevalence of GDM progressively rose (P < 0.001). However, the area under the curve of the receiver-operating characteristic curve for FCG in predicting GDM was modest (0.67). Although using an FCG threshold of 4.8 mmol/L could reduce the number of OGTTs by 28.4%, this approach would miss 18.2% of cases of GDM. CONCLUSION Fasting capillary glucose is associated with glycemia, insulin sensitivity, and pancreatic beta-cell function. However, a single FCG measurement is insufficient for reliably ruling out GDM after an abnormal GCT.
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Affiliation(s)
- Valerie Anderson
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON
| | - Chang Ye
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON
| | - Mathew Sermer
- Division of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
| | - Philip W Connelly
- Division of Endocrinology, University of Toronto, Toronto ON; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto ON
| | - Anthony J G Hanley
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON; Division of Endocrinology, University of Toronto, Toronto ON; Department of Nutritional Sciences, University of Toronto, Toronto ON
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON; Division of Endocrinology, University of Toronto, Toronto ON; Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto ON
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON; Division of Endocrinology, University of Toronto, Toronto ON; Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto ON
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Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, Kozak S, Ryan E, Sermer M, Vinokuroff C. Diabetes and pregnancy. Can J Diabetes 2013; 37 Suppl 1:S168-83. [PMID: 24070943 DOI: 10.1016/j.jcjd.2013.01.044] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Falavigna M, Prestes I, Schmidt MI, Duncan BB, Colagiuri S, Roglic G. Impact of gestational diabetes mellitus screening strategies on perinatal outcomes: a simulation study. Diabetes Res Clin Pract 2013; 99:358-65. [PMID: 23332050 DOI: 10.1016/j.diabres.2012.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 11/26/2012] [Accepted: 12/13/2012] [Indexed: 12/14/2022]
Abstract
AIMS To evaluate the impact on perinatal outcomes of universal gestational diabetes (GDM) screening based on 1999 WHO and IADPSG diagnostic criteria; to assess the quality of the evidence (GRADE) to support GDM screening. METHODS Simulation of a hypothetical cohort of community-based pregnant women with 10% GDM prevalence (1999 WHO). Most parameters were obtained from recent systematic reviews. RESULTS Compared to no screening, screening based on 1999 WHO criteria (followed by treatment) reduced the incidence of large for gestational age (LGA) neonates by 0.53% (95% CI 0.37-0.74%; NNS=189) and of preeclampsia by 0.27% (0.10-0.45%; NNS=376). Screening based on IADPSG criteria reduced incidences by 0.85% (0.54-1.29%; NNS=117) and by 0.39% (0.15-0.65%; NNS=257), respectively. Compared to screening based on 1999 WHO criteria, screening with IADPSG criteria reduced the incidence of LGA by 0.32% (0.09-0.63%; NNS=309) and of preeclampsia by 0.12% (0.01-0.25; NNS=808). The quality of evidence for both screening approaches is very low. CONCLUSIONS Universal screening for GDM has only a modest impact on pregnancy outcomes. The impact of screening based on IADPSG (vs. WHO, 1999) criteria is slightly larger. However, costs and resources should also be considered in local selection of a screening approach.
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Affiliation(s)
- Maicon Falavigna
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Zhao X, Zhao W, Zhang H, Li J, Shu Y, Li S, Cai L, Zhou J, Li Y, Hu R. Fasting capillary blood glucose: an appropriate measurement in screening for diabetes and pre-diabetes in low-resource rural settings. J Endocrinol Invest 2013; 36:33-7. [PMID: 22453076 DOI: 10.3275/8304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the efficiency of fasting capillary blood glucose (FCG) measurement as compared with fasting venous plasma glucose (FPG) measurement in screening diabetes and pre-diabetes in low-resource rural settings. SUBJECTS AND METHODS In 2010, 993 participants were randomly selected from 9 villages in Yunnan province using cluster sampling method. Samples for FCG and FPG test were obtained after demographics and physical examination. The oral glucose tolerance test was performed in parallel as gold standard for diagnosis. Diagnostic capacities of the FCG measurement in predicting undiagnosed diabetes and pre-diabetes were assessed. The performance of FCG and FPG tests was compared. RESULTS Fifty-seven individuals with undiagnosed diabetes and 145 subjects with pre-diabetes were detected. The concordance between FCG and FPG levels was high (r = 0.75, p < 0.001). The area under the curve (AUC) for FCG test in predicting diabetes was 0.88 [95% confidence interval (CI) 0.82-0.93] with the optimal cutoff value of 5.65 mmol/l, sensitivity of 84.2%, and specificity of 79.3%. The corresponding values in FPG tests were 0.92 (95% CI 0.88-0.97) (AUC), 6.51 mmol/l (optimal cutoff point), 82.5% (sensitivity) and 98.3% (specificity), respectively. No significant difference was found in the AUC for the two screening strategies. CONCLUSION FCG measurement is considered to be a convenient, practicable screening method in low-resource rural communities with acceptable test properties.
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Affiliation(s)
- X Zhao
- Department of Endocrinology and Metabolism, HuaShan Hospital, No.12, Wulumuqi Middle Road, Shanghai 200040, China
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Rehder PM, Pereira BG, e Silva JLP. The prognostic value of a normal oral glucose tolerance test in pregnant women who tested positive at screening: a validation study. Diabetol Metab Syndr 2012; 4:10. [PMID: 22472182 PMCID: PMC3349605 DOI: 10.1186/1758-5996-4-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/03/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Controversies surround a diagnosis of gestational diabetes mellitus (GDM). The objective of this study was to evaluate the oral glucose tolerance test (OGTT) for the prediction of adverse gestational and perinatal outcomes in pregnant women with a positive screening test for diabetes mellitus and a negative diagnosis, i.e. a normal 3-hour OGTT. METHODS This validation study evaluated 409 pregnant women who tested positive for diabetes mellitus at screening. Perinatal and maternal outcomes were considered. Sensitivity and specificity were calculated for each of the values of the OGTT as a diagnostic test, with the gold standard being perinatal outcome. RESULTS The most frequent risk factors were obesity, arterial hypertension and advanced maternal age. The most common neonatal outcomes were large-for-gestational-age infants, Cesarean delivery and preterm birth. A fasting blood glucose level of 87 mg/dL was the most powerful predictor of adverse perinatal outcome. CONCLUSIONS At the cut-off level adopted by the American Diabetes Association, gestational OGTT was able to successfully identify in which pregnant women outcome would be unfavorable.
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Affiliation(s)
- Patricia M Rehder
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Obstetrics & Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Belmiro G Pereira
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- The Prof. Dr. José A. Pinotti Women's Hospital, a Teaching Hospital of the University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - João Luiz Pinto e Silva
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- The Prof. Dr. José A. Pinotti Women's Hospital, a Teaching Hospital of the University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Agarwal MM, Weigl B, Hod M. Gestational diabetes screening: the low-cost algorithm. Int J Gynaecol Obstet 2012; 115 Suppl 1:S30-3. [PMID: 22099438 DOI: 10.1016/s0020-7292(11)60009-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The American Diabetes Association has endorsed the demanding recommendation by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) that every pregnant woman should undergo the oral glucose tolerance test (OGTT) for the screening of gestational diabetes mellitus (GDM). The aim of this study was to find out if the fasting plasma glucose (FPG) and newer emerging technologies could simplify the cumbersome IADPSG algorithm. Two FPG thresholds (of the OGTT) were used to rule in and rule out GDM in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort (n = 23316) and a population at high risk for GDM (n = 10283). For the HAPO cohort and the high-risk population, respectively, FPG thresholds of: (a) ≥ 5.1 mmol/L (specificity 100%) independently ruled in GDM in 1769 (8.3%) women and 2975 (28.9%) women; and (b) ≤ 4.4 mmol/L ruled out GDM in 11526 (49.4%) women (84.1% sensitivity) and 2228 (21.7%) women (95.4% sensitivity). Use of the FPG independently could have avoided 13295 (57.0%) and 5203 (50.6%) OGTTs in the 2 groups. The initial FPG-by significantly reducing the number of cumbersome OGTTs needed-can make the IADPSG recommendations more acceptable worldwide. The number of GDM women missed is population dependent. For low-resource countries, alternative newer and cheaper tests in development hold an exciting future.
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Affiliation(s)
- Mukesh M Agarwal
- Department of Pathology, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
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Dhatt GS, Agarwal MM, Othman Y, Nair SC. Performance of the Roche Accu-Chek active glucose meter to screen for gestational diabetes mellitus using fasting capillary blood. Diabetes Technol Ther 2011; 13:1229-33. [PMID: 21864017 DOI: 10.1089/dia.2011.0097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Point-of-care (POC) blood glucose measurement using glucose meters is used by diabetes patients to mange their disease. POC glucose testing also is also used in tight glycemic control protocols and as a screening tool for diabetes. We report the performance and effectiveness of the Accu-Chek® Active (Roche Diagnostics GmbH, Mannheim, Germany) glucose meter to screen for gestational diabetes mellitus (GDM) using blood fasting capillary glucose (FCG). METHODS To screen for GDM, 1,465 pregnant women underwent an oral glucose glucose tolerance test. Correlation between the FCG and fasting plasma glucose (FPG) levels was determined by Passing and Bablok regression analysis. Total error (TE) of the glucometer was ascertained using the Bland-Altman method with the DXC-800 analyzer (Beckman-Coulter Instruments, Brea, CA) as the reference method. The area under the receiver operator characteristic curve was used to analyze the performance of the FCG to predict GDM. RESULTS FPG and FCG identified 361 (24.6%) and 338 (23%) women as having GDM, respectively. The Bland-Altman TE at 95% limits of agreement was -11.1% to 10.8%. The area under the receiver operator characteristic curve was 0.953 (95% confidence interval 0.943 to 0.964). CONCLUSIONS The Roche Accu-Chek Active glucometer meets analytical and clinical quality requirements. A TE of±15% is acceptable for glucose meters used in ambulatory care, including home self-monitoring of blood glucose, and different TE targets should be set for acute critical care settings.
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Affiliation(s)
- Gurdeep S Dhatt
- Department of Laboratory Medicine, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates.
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Abstract
Gestational diabetes mellitus is defined as glucose intolerance that begins or is first recognized during pregnancy. Its prevalence, generally situated between 2-6%, may reach 10-20% in high-risk populations, with an increasing trend across most racial/ethnic groups studied. Among traditional risk factors, previous gestational diabetes, advanced maternal age and obesity have the highest impact on gestational diabetes risk. Racial/ethnic origin and family history of type 2 diabetes have a significant but moderate impact (except for type 2 diabetes in siblings). Several non traditional factors have been recently characterized, either physiological (low birthweight and short maternal height) or pathological (polycystic ovaries). The multiplicity of risk factors and their interactions results in a low reliability of risk prediction on an individual basis.
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Affiliation(s)
- F Galtier
- HRU Montpellier, Centre d'investigation clinique et Département des Maladies Endocriniennes,, 34295 Montpellier cedex 05, France.
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Agarwal MM, Dhatt GS, Othman Y, Ljubisavljevic MR. Gestational diabetes: an evaluation of serum fructosamine as a screening test in a high-risk population. Gynecol Obstet Invest 2010; 71:207-12. [PMID: 21160150 DOI: 10.1159/000318705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 07/05/2010] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the value of serum fructosamine as a screening test for gestational diabetes mellitus (GDM). METHODS 849 pregnant women underwent the one-step 75 g oral glucose tolerance test (OGTT) for universal screening of GDM. The fasting serum fructosamine (cFruc) was assessed using the area under the receiver operating characteristic curve (AUC). The GDM diagnostic criteria used were those of the American Diabetes Association; however, the cFruc performance was also evaluated using criteria of the World Health Organization, Australian (ADIPS), European (EASD) and International Association of Diabetes and Pregnancy Study Groups (IADPSG). RESULTS 113 (13.3%) women had GDM. The AUC of the cFruc was 0.60 (95% CI 0.54-0.66). A cFruc threshold of 237 μmol/l achieved an acceptable sensitivity of 85.8% (95% CI 78.0-91.0%), but the associated specificity remained poor at 23.4% (95% CI 20.0-27.0%) with a positive predictive value of just 14.7%. Overall, over 4 out of 5 pregnant women, being over this cutoff, would need the confirmatory OGTT. No cFruc threshold reached acceptable likelihood ratios to rule-in or rule-out GDM. The AUC for cFruc remained unacceptable independent of the diagnostic criteria. CONCLUSIONS Despite all the advances in technology, serum fructosamine is a poor test to screen for GDM.
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Affiliation(s)
- Mukesh M Agarwal
- Department of Pathology, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates.
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Agarwal MM, Dhatt GS, Shah SM. Gestational diabetes mellitus: simplifying the international association of diabetes and pregnancy diagnostic algorithm using fasting plasma glucose. Diabetes Care 2010; 33:2018-20. [PMID: 20519664 PMCID: PMC2928355 DOI: 10.2337/dc10-0572] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the impact of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria on 1) gestational diabetes mellitus (GDM) diagnosis compared with the American Diabetes Association (ADA) criteria and 2) the fasting plasma glucose (FPG) to predict GDM. RESEARCH DESIGN AND METHODS In 10,283 pregnant women undergoing a 75-g oral glucose tolerance test (OGTT) for universal screening of GDM, two FPG thresholds (of the OGTT) were used to rule in and to rule out GDM. RESULTS The IADPSG and ADA criteria identified GDM in 3,875 (37.7%) women and 1,328 (12.9%) women, respectively (P < 0.0005). FPG thresholds of >or=5.1 mmol/l ruled in GDM in 2,975 (28.9%) women with 100% specificity, while <4.4 mmol/l ruled out GDM in 2,228 (21.7%) women with 95.4% sensitivity. FPG independently could have avoided the OGTT in 5,203 (50.6%) women. CONCLUSIONS The IADPSG criteria increased GDM prevalence nearly threefold. By circumventing a significant number of OGTTs, an initial FPG can greatly simplify the IADPSG diagnostic algorithm.
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Affiliation(s)
- Mukesh M Agarwal
- Department of Pathology, Faculty of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.
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Waugh N, Pearson D, Royle P. Screening for hyperglycaemia in pregnancy: Consensus and controversy. Best Pract Res Clin Endocrinol Metab 2010; 24:553-71. [PMID: 20832736 DOI: 10.1016/j.beem.2010.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Policy decisions on whether to implement screening programmes depend on whether the proposed programmes meet a set of criteria laid down by the World Health Organization. Screening for hyperglycaemia in pregnancy (HGP) does not meet all the criteria. However the case for screening has been strengthened by a number of recent developments, including: rising prevalence of HGP because of increasing maternal age and BMI; the results of the Hyperglycaemia and Adverse Pregnancy Outcomes study, showing that adverse effects of HGP are seen over a wider range of plasma glucose levels than previously thought; two large trials which showed the benefits of treating lesser degrees of HGP; trials showing that metformin and glibenclamide were effective and safe alternatives to immediate insulin in those without good control on lifestyle measures alone. However uncertainties remain around the threshold for treatment, and on the best screening strategy.
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Affiliation(s)
- Norman Waugh
- Department of Public Health Medical School Buildings, Foresterhill, Aberdeen, UK.
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